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Why Can’t Veterans Get Medical Marijiuana for PTSD When People (and Even Dogs) Can in 33 States?
For 21 years, Doug Distaso served his country in the United States Air Force.
He commanded joint aviation, maintenance, and support personnel globally and served as a primary legislative affairs lead for two U.S. Special Operations Command leaders.
But after an Air Force plane accident left him with a traumatic brain injury, post-traumatic stress disorder (PTSD), and chronic pain, Distaso was placed on more than a dozen prescription medications by doctors at the U.S. Department of Veterans Affairs (VA).
"I was taking everything from opioids and antidepressants to benzodiazepines and sleeping pills," Distaso told Healthline. "Like countless other veterans, this combat cocktail of drugs I was prescribed quickly threw my life into a tailspin, affecting my ability to perform at work and straining my relationships at home."
Distaso says that living his life in a prescription pill-induced, zombie-like state left his wife and family pleading with him on Christmas morning to come back to them.
"What brought me back to my family, my career, and myself was medical cannabis. It helped me get off the pills and back in control of every facet of my life," Distaso said.
"Sadly, for millions of veterans who rely solely on their VA healthcare benefits, federal law ties the hands of their VA doctors and cruelly denies these veterans access to medical cannabis as a treatment option," he said.
Distaso now works for his fellow veterans as executive director of the Veterans Cannabis Project, which advocates for veterans' cannabis access, education of policymakers, and support for veterans who are seeking treatment options beyond the opiates and other addictive drugs they can get from the VA.
"It is time for Congress to authorize doctors at the VA to recommend and assist veterans in accessing medical cannabis and require the VA to research the impacts of cannabis on common veterans' health issues," Distaso said.
The VA Denial of Cannabis
On the VA's website, marijuana use is still labeled as harmful to veterans.
"Marijuana use for medical conditions is an issue of growing concern," the VA states.
Marijuana also remains on the Schedule I list under the Controlled Substances Act, the same level as heroin.
According to the VA website, "controlled studies have not been conducted to evaluate the safety or effectiveness of medical marijuana for PTSD. Thus, there is no evidence at this time that marijuana is an effective treatment for PTSD."
However, the tide has turned nationally in terms of the attitude toward marijuana, especially for medicinal purposes.
Despite the unavailability of medicinal marijuana at the VA, veterans nationwide are using cannabis to deal with their PTSD symptoms such as anxiety and depression as well as chronic pain.
And a growing number of scientific studies are showing the medicinal properties of cannabis.
On its website, VA downplays the widespread acceptance of marijuana in the U.S., stating that "several" states have approved the use of marijuana for medical and/or recreational use.
It's actually far more than "several."
To date, 33 states and the District of Columbia have enacted medical marijuana laws that allow eligible people to obtain or grow cannabis to treat a range of conditions.
Results of a new poll from Politico and Harvard's T.H. Chan School of Public Health show that Americans now think marijuana is much less harmful than alcohol, tobacco, or e-cigarettes.
In the survey, 1 in 5 Americans said they believe marijuana is very harmful to people who use it. Twice as many said the same about alcohol, 52 percent characterized e-cigarettes as very harmful, and 80 percent said tobacco cigarettes are very harmful.
And more than 6 in 10 U.S. adults said they favor changing federal law to legalize marijuana for recreational use.
It's the third national survey released within the past month showing strong majority support among Americans for legalizing marijuana.
In addition, almost all of the Democratic presidential candidates agree on removing marijuana from the federal list of controlled substances.
And veterans and the American public in general overwhelmingly support medicinal cannabis for veterans.
In a 2017 survey by the American Legion, 92 percent of veterans said they supported research into medical cannabis and 83 percent support legalizing medical cannabis.
New Study on PTSD and Cannabis
A new study published last week concludes that cannabis may already be helping Canadians cope with the symptoms of depression and thoughts of suicide in people with PTSD.
In an analysis of health survey data collected from more than 24,000 Canadians, researchers from the British Columbia Centre on Substance Use (BCCSU) and University of British Columbia concluded that people who have PTSD but do not medicate with cannabis are far more likely to suffer from severe depression and have suicidal thoughts than those who reported cannabis use over the past year.
The authors concluded that the study provides preliminary evidence that "cannabis use may contribute to reducing the association between post-traumatic stress disorder and severe depressive and suicidal states."
Stephanie Lake, a research assistant at the BCCSU who led the study, told Newsweek:
"We know that with limited treatment options for PTSD, many patients have taken to medicating with cannabis to alleviate their symptoms. However, this is the first time that results from a nationally representative survey have shown the potential benefits of treating the disorder with cannabis."
This analysis is the first to document the relationships between PTSD, cannabis use, and severe mental health outcomes in a sample representative of the population.
And it begs the question: If a Canadian health survey looked at PTSD and cannabis and came to this conclusion, where is the VA on this issue, which affects as many as 30 percent of the American men and women who served in the wars since the September 2001 terrorist attacks?
Veterans Group Supports Medical Cannabis
Lindsay Rodman, a Marine veteran who served in Afghanistan, is now executive vice president of communications and legal strategy at Iraq and Afghanistan Veterans of America (IAVA), the country's largest veteran service organization for post-9/11 war veterans.
She told Healthline that while the VA says it is not allowed to do research, that isn't true.
"They just have to coordinate with other agencies. Just do it," Rodman said.
As a nonpartisan group, Rodman says, "IAVA believes it is important that both sides of the aisle take these issues more seriously."
IAVA's most recent annual national survey showed that 1 in 5 of its members use medical marijuana, according to Rodman.
But fewer than one-third of those veterans said they mentioned this to their doctor because of the stigma attached to marijuana use.
Veterans have legitimate fear of reprisals at VA and in the workforce, where one can lose a job for testing positively for pot.
"We have found anecdotally that in parts of the country where the use of cannabis is less stigmatized, such as San Francisco, they can have an open conversation with the VA physicians," Rodman said. "But in parts of the country where it is still illegal, such as Georgia, providers are more skeptical or judgmental and it shuts up the veteran, and then the veterans do not communicate openly with their provider, and that is dangerous."
Why the VA Won't Budge
The biggest hurdle for veterans seeking cannabis at the VA is that it is still on that Schedule I list of controlled substances.
This means that cannabis still is identified by the federal government as having "no acceptable medical use [and a] high potential for abuse" and risk for arrest with use.
The VA considers all forms of marijuana illegal, meaning veterans can't get help accessing medical marijuana from their VA doctors and have to get it on their own.
During a recent Congressional hearing exploring bills that would allow for expanded access to medical marijuana for veterans, VA representatives reaffirmed their position opposing such policies as long as marijuana remains illegal at the federal level.
Susan Carter, director of media relations at the VA, told Healthline that her agency is "committed to improving treatment options for veterans and supports research into potential treatment options that may prove valuable."
Carter explains that federal law restricts the VA's ability to conduct research with Schedule I controlled substances, including marijuana.
She adds that conducting any VA research using Schedule I controlled substances "would involve interactions with the Food and Drug Administration (FDA), Health and Human Services, National Institutes of Health , National Institute on Drug Abuse, and the Drug Enforcement Administration (DEA)."
She says that these requirements include "review of an investigational new drug application and approval of the research protocol by the FDA; an investigator registration and site licensure by the DEA; and obtaining the medical drug through NIDA and the nationally approved medical marijuana production laboratory."
"The restrictions contained in federal law are clear. Some research is allowed, but must be done in conjunction with the aforementioned federal entities," Carter said. "If Congress wants to facilitate more federal research into Schedule I controlled substances such as marijuana, it can always choose to eliminate these restrictions."
Multiple sources tell Healthline that it isn't just Congress, but the president who can reschedule marijuana and make it available to veterans and make it easier to study by VA scientists.
The executive branch rescheduling is a complicated process involving the FDA and the DEA, among other federal agencies, but multiple sources tell Healthline that it is indeed possible for the president to reschedule a drug.
Despite stating at times that he supports marijuana legalization, President Trump has not yet removed cannabis from Schedule I status.
Former VA Secretary Wants More Research
Dr. David Shulkin, a physician who was secretary of the VA from early 2017 until March 28, 2018, when he was removed by President Trump, says the president can reschedule marijuana.
"There was a change in 2014 when the Drug Enforcement Administration changed hydrocodone combination products from III to Schedule II," Shulkin told Healthline. "It has been done before and that is the executive branch. Does the White House usually get involved at that level? No, they don't. But there is a process to change that. The White House could weigh in on this and the FDA and DEA would follow the normal process."
Shulkin says that the VA has an obligation to study cannabis.
"It's a little bit strange that marijuana is Schedule I and cocaine is Schedule II," Shulkin said. "To say there is no medicinal value or application in cannabinoids is just not true."
Shulkin says there is "already an FDA-approved drug, which is a cannabinoid, for pediatric epilepsy. It is on the market."
Approved by the FDA in June 2018, Epidiolex, is the first drug derived from the cannabis plant in the U.S. to reach local pharmacies.
"I believe there are also some applications accepted for increasing appetite in chemotherapy patients and others," said Shulkin.
He added that when he led the VA, he was told the agency wasn't allowed to even discuss cannabis with veterans and was not allowed to do research.
But he later learned that this was not true.
"We can talk to our patients about it. We just can't prescribe the cannabis," said Shulkin, who writes about his evolving view on medicinal cannabis in his new book, "It Shouldn't Be This Hard to Serve Your Country: Our Broken Government and the Plight of Veterans."
"We can do research at the VA, but unfortunately the barriers and bureaucracy you have to go through are lengthy and painful," he said. "I can now more effectively articulate the view that Congress is the most likely player to help in streamlining research. And yes, it needs to be done."
Medical Marijuana Research
The Center for Medicinal Cannabis Research (CMCR) at the University of California San Diego School of Medicine is the nation's oldest research center for scientific inquiry into the safety and efficacy of cannabis.
CMCR recently announced five new grants worth a total of $3 million to explore the efficacy and safety of medical cannabis as a supplementary or alternative treatment for schizophrenia, rheumatoid arthritis, insomnia, alcohol dependence, and anxiety linked to anorexia.
Research done by CMCR has also shown cannabis to be effective for relieving pain, but there is no such research at CMCR when it comes to studying cannabis for PTSD.
The center, which is directly linked to the VA's regional office in San Diego, does not have any current studies looking at cannabis and PTSD.
Legislation Is Not Moving
Members of Congress have tried to push for new legislation to make medical marijuana available to veterans at the VA. But without success.
Below are just some of the bills that have not moved forward:
The Veterans Equal Access Act would allow VA health providers to recommend medical marijuana to their veteran patients and fill out the necessary paperwork for them to enroll in state marijuana programs.
The VA Medicinal Cannabis Research Act would direct the VA to conduct a large-scale clinical trial on the effects of cannabis on conditions such as PTSD and chronic pain.
The VA Medicinal Cannabis Research Act of 2018 would support scientific and medical research into medicinal cannabis for veterans diagnosed with PTSD, TBI, chronic pain, and other illnesses and injuries by clarifying that research into medicinal cannabis is within the authority of the VA.
And the Veterans Medical Marijuana Safe Harbor Act would enable VA physicians to issue medical cannabis recommendations in accordance with the laws of states where medical cannabis is legal.
The Safe Harbor Act would also require VA to conduct studies on the effects of medical marijuana on veterans in pain and the relationship between treatment programs involving medical marijuana that are approved by states, the access of veterans to such programs, and a reduction in opioid abuse among veterans.
Ok for Dogs but Not Veterans?
Rodman says it is absurd that Americans in the majority of states now have access to medicinal marijuana but America's veterans do not.
"I have a friend who is not a veteran and does not know too much about veteran issues, and he receives medical marijuana for his dog's anxiety," Rodman said. "He was shocked when I told him that while he can get medicinal marijuana for his dog, a veteran cannot get the same treatment at the VA."
IAVA is an outspoken advocate for veterans who seek medicinal marijuana.
Rodman believes that while there is not currently a large appetite in Washington, D.C., for this issue, there is outside the Beltway.
"I think it's actually a Washington, DC, echo chamber, it is circular logic," Rodman said. "We at IAVA are convinced there is a national appetite for this issue, but politicians in DC only hear themselves and continue to assume that there isn't."
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